Objective To evaluate the early effectiveness of navigation-free robot-assisted total knee arthroplasty (TKA) compared to traditional TKA in the treatment of knee osteoarthritis combined with extra-articular deformities. Methods The clinical data of 30 patients with knee osteoarthritis combined with extra-articular deformities who met the selection criteria between June 2019 and January 2024 were retrospectively analyzed. Fifteen patients underwent CORI navigation-free robot-assisted TKA and intra-articular osteotomy (robot group) and 15 patients underwent traditional TKA and intra-articular osteotomy (traditional group). There was no significant difference in age, gender, body mass index, affected knee side, extra-articular deformity angle, deformity position, deformity type, and preoperative knee range of motion, American Knee Society (KSS) knee score and KSS function score, and lower limb alignment deviation between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications of the two groups were recorded and compared. The knee range of motion and lower limb alignment deviation were recorded before operation and at 6 months after operation, and the knee joint function was evaluated by KSS knee score and function score. Results There was no significant difference in operation time between the two groups (P>0.05); the intraoperative blood loss in the robot group was significantly less than that in the traditional group (P<0.05). Patients in both groups were followed up 6-12 months, with an average of 8.7 months. The incisions of all patients healed well, and there was no postoperative complication such as thrombosis or infection. At 6 months after operation, X-ray examination showed that the position of the prosthesis was good in both groups, and there was no loosening or dislocation of the prosthesis. The knee joint range of motion, the lower limb alignment deviation, and the KSS knee score and KSS function score significantly improved in both groups (P<0.05) compared to preoperative ones. The changes of lower limb alignment deviation and KSS function score between pre- and post-operation in the robot group were significantly better than those in the traditional group (P<0.05), while the changes of other indicators between pre- and post-operation in the two groups were not significant (P>0.05). Conclusion Compared to traditional TKA, navigation-free robot-assisted TKA for knee osteoarthritis with extra-articular deformities results in less intraoperative blood loss, more precise reconstruction of lower limb alignment, and better early effectiveness. However, long-term effectiveness require further investigation.
ObjectiveTo observe the character of spino-pelvic sagittal alignment in patients with high-grade L5 isthmic spondylolisthesis, and to analyze the sagittal alignment alteration after operation. MethodBetween January 2009 and June 2014, 25 patients with high-grade L5 isthmic spondylolisthesis underwent posterior surgery, and the clinical data were retrospectively analyzed as study group. There were 14 males and 11 females with a mean age of 42.5 years (range, 20-65 years). The mean disease duration was 6 months (range, 3-12 months). According to the Meyerding evaluating system, 15 cases were rated as degree III, and 10 cases as degree IV. Eighty healthy adult volunteers were recruited simultaneously as control group. The lumbar sacral angle (LSA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured on preoperative and last follow-up standing full length lateral X-ray films. And these parameters were compared between study group (preoperative parameters) and control group. Then the patients in study group were divided into 2 subgroups according to Hresko's method:the balanced pelvis subgroup (n=14) and unbalanced pelvis subgroup (n=11) . The sagittal parameters were compared between 2 subgroups, and the alteration of sagittal parameters before surgery and at last follow-up was analyzed in each subgroup respectively. ResultsAll patients in study group were followed up 18 months on average (range, 6-48 months). After surgery, spondylolisthesis was reduced from degree III to degree 0 in 12 cases and to degree I in 3 cases, and from degree IV to degree 0 in 6 cases and to degree I in 4 cases. Bone fusion was obtained in all patients at last follow-up. The preoperative PI, SS, PT, and SVA of study group were significantly greater than those of control group (P<0.05) , while the TK was significantly smaller than that of control group (P<0.05) . In the balanced pelvis subgroup, LSA, LL, and SVA at last follow-up significantly decreased while TK significantly increased when compared with preoperative ones (P<0.05) . In the unbalanced pelvis subgroup, LSA, PT, and SVA at last follow-up significantly decreased while SS, LL, and TK significantly increased when compared with preoperative ones (P<0.05) . The preoperative LSA and PT in the unbalanced pelvis subgroup were significantly greater, while SS, LL, and TK were significantly smaller than those of balanced pelvis subgroup (P<0.05) ; while at last follow-up, significant differentce was found only in LSA between 2 subgroups (P<0.05) . ConclusionsThe LSA should be paid more attention in surgery to assure recovery of the sagittal balance because patients with high-grade L5 isthmic spondylolisthesis have greater PI, abnormal lumbosacral kyphosis, and sagittal imbalance.
Objective To investigate the effect of Navio robot-assisted unicompartmental knee arthroplasty (UKA) on the biomechanics of knee joint during sitting-up movement, and to determine whether UKA can maintain the biomechanical characteristics of knee joint. Methods The clinical data of 8 patients with medial compartment osteoarthritis treated with medial fixed platform of Navio robot-assisted UKA between January 2018 and January 2019 and had the complete follow-up data were retrospectively analyzed. There were 4 males and 4 females; the age ranged from 58 to 67 years, with an average of 62.3 years. The disease duration was 6-18 months, with an average of 13 months. The varus deformity ranged from 4° to 6°, with an average of 5°; the knee flexion range of motion was 0°-130°, with an average of 110°. All patients had no extension limitation. The imaging data of bilateral knees during sitting-up movement were collected by biplane C-arm X-ray machine at 3 weeks before operation and 7 months after operation. The three-dimensional models of femur and tibia were established by dual-energy CT scanning, and the three-dimensional models of femur and tibia were matched and synchronized with the femur and tibia in X-ray film by automatic matching tracer software. The biomechanical parameters of femur and tibia were measured, including internal rotation/external rotation, varus/valgus, forward/backward displacement of medial and lateral tibia contact center, and lateral compartment joint space. Results Eight patients were followed up 5-7 months, with an average of 6.4 months. In the comparison of the affected side before and after operation, except for the difference of varus/valgus which was significant (t=4.959, P=0.002), the differences in other indicators was not significant (P>0.05). There were significant differences in varus/valgus and internal rotation/external rotation between healthy and affected sides at 3 weeks before operation (P<0.05), and the differences in other indicators was not significant (P>0.05). At 7 months after operation, the difference in the forward and backward displacement of medial tibia contact center was significant (t=3.798, P=0.007), and the differences in other indicators was not significant (P>0.05). Conclusion UKA can effectively correct the varus and valgus of the knee joint, and restore the rotational biomechanical characteristics of the affected knee joint. It does not affect the establishment of the lateral compartment joint space, but the medial and lateral tibia contact center still changes.
ObjectiveTo review the research progress of the diagnosis and treatment of Hangman fracture. MethodsThe original articles about the diagnosis and treatment of Hangman fracture were extensively reviewed and analyzed. ResultsNot only X-ray, but also MRI and CT scans are necessory for the diagnosis and assessment of Hangman fractures. The treatment of unstable Hangman fracture included posterior C2, C3 fixation, anterior C2, C3 fixation, and anterior C2, C3 fixation combined with posterior C2 pedicle screw fixation. The anterior surgical fixation is used by the anterior retropharyngeal approach or subaxial anterior approach, and it has the advantages of directly resecting the injured C2, C3 discs, getting a satisfactory cervical spine alignment, and avoiding the postoperative axial pain. However, posterior surgical fixation using C2 pedicle screw has the risks of neurovascular injuries. ConclusionThe surgical technique of Hangman fracture should be determined based on the patient's injury and surgeon's experience. Randomized control trials of different surgical techniques should be performed.
ObjectiveTo investigate the short-term effectiveness of novel computer navigation system (Knee 3 software; Brainlab, Germany) assisted total knee arthroplasty (TKA).MethodsBetween July 2020 and December 2020, 19 patients underwent unilateral TKA assisted with Knee 3 software. There were 4 males and 15 females. The mean age was 66.3 years (range, 52-79 years). Eighteen patients were diagnosed with osteoarthritis and 1 patient with rheumatoid arthritis. Sixteen patients had varus knees and 3 patients had valgus knees. Preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain, stiffness, function, and total scores were 12.4±3.4, 2 (1, 4), 22 (18, 29), and 37 (29, 43), respectively. Intraoperatively, the medial and lateral gaps in knee extension and in 90° of knee flexion were recorded. The operation time, intraoperative blood loss, blood transfusion, and complications were recorded. The hip-knee-ankle angle (HKA), lateral distal femoral angle, and medial proximal tibial angle were measured to evaluate lower limb alignment and prostheses’s alignment using X-ray films at 6 weeks after operation. Patient’s satisfaction rate and WOMAC pain, stiffness, function, and total scores were investigated.ResultsEighteen patients (94.7%) had medial- lateral gap balancing in knee extension, 18 patients (94.7%) had medial-lateral gap balancing in 90° of knee flexion, 19 patients (100%) had medial gap balancing between knee extension and 90° of knee flexion, and 18 patients (94.7%) had lateral gap balancing between knee extension and 90° of knee flexion. The mean operation time was 126 minutes (range, 100-200 minutes). The mean intraoperative blood loss was 205 mL (range, 100-400 mL). Patients were followed up 4-8 months, with an average of 6.2 months. Postoperative complications included 1 deep vein thrombosis of lower extremities and 1 cerebral infarction. X-ray films showed that the mean HKA, lateral distal femoral angle, and medial proximal tibial angle were 179.8° (range, 178°-182°), 83.5° (range, 80°-87°), and 89.5° (range, 87°-93°), respectively. At last follow-up, WOMAC pain, stiffness, function, and total scores were 3.6±1.9, 0 (0, 2), 4 (2, 6), and 9 (5, 10), respectively, which improved when compared with preoperative scores (P<0.05). Twelve patients were very satisfied with the operation results and 7 patients were satisfied with the operation results. The overall satisfaction rate was 100%.ConclusionKnee 3 software can help to obtain good gap balancing and optimal lower limb alignment, with high patient’s satisfaction and good short-term effecectiveness.
ObjectiveTo evaluate the effects of the improved precision alignment method of lower limbs mecha-nical alignment for osteoarthritis of the knee in open wedge high tibial osteotomy (OWHTO).MethodsA retrospective analysis was made on the clinical data of 62 patients (68 knees) with knee osteoarthritis in the medial compartment treated with OWHTO between January 2012 and December 2015 who accorded with the inclusion criteria. The traditional method for positioning lower limb mechanical force line was used in 29 cases (32 knees) (traditional group), and improved method for positioning lower limb mechanical force line in 33 cases (36 knees) (modified group). There was no significant difference in gender, age, side, course of disease, and osteoarthritis grading between two groups (P>0.05) with comparable. The operation time, intraoperative fluoroscopy times, and intraoperative blood loss were recorded in two groups; Before and after operation, the lower limb mechanical force line was observed on the X-ray films, which was expressed by hip-knee-ankle angle (HKA). The clinical efficacy was evaluated by the American Hospital for Special Surgery (HSS) score, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC).ResultsIncision hematoma occurred in 1 case of traditional group and was cured at 3 weeks after symptomatic treatment; and primary healing was obtained in the other patients, with no early complications. The operation time and intraoperative fluoroscopy times of the modified group were significantly lower than those of the traditional group (t=11.934, P=0.000; t=11.663, P=0.000), but there was no significant difference in blood loss between the two groups (t=0.209, P=0.835). The patients were followed up for 6 to 24 months (mean, 12.7 months) in the traditional group and for 3 to 22 months (mean, 13.2 months) in the modified group. The medial knee pain disappeared in all patients. At last follow-up, the HSS score and WOMAC score were significantly improved when compared with preoperative scores in two groups (P<0.05), but there was no significant difference between the two groups (P>0.05). Postoperative X-ray examination showed that the tibiofemoral angle was corrected in the two groups. The HKA angle at immediate after operation and last follow-up was significantly higher than angle at pre-operation in two groups (P<0.05), but there was no significant difference between at immediate after operation and at last follow-up (P>0.05).ConclusionCompared with the traditional method for positioning lower limb mechanical force line, the improved precision alignment method can reduce the times of intraoperative fluoroscopy and shorten the operation time, which reduces the radiation exposure of both doctors and patients.
Objective To explore the prediction of postoperative coronal lower limb alignment by the tibia fibular angle (TFA) and femoral fibular angle (FFA) after osteotomy in medial open-wedge high tibial osteotomy (MOWHTO). Methods A clinical data of 20 patients with medial compartment osteoarthritis, who were treated with MOWHTO between September 2019 and September 2020, was retrospectively analyzed. Among them, there were 9 males and 11 females; the age ranged from 46 to 69 years, with an average of 56.0 years. The body mass index (BMI) was 21.3- 35.7 kg/m2, with an average of 26.7 kg/m2. Osteoarthritis involved 11 cases of left knee and 9 cases of right knee; the disease duration was 2-6 years, with an average of 3.8 years. According to the Kellgren-Lawrence classification, there were 7 cases of grade Ⅰ, 9 cases of grade Ⅱ, and 4 cases of grade Ⅲ. The angle and height for open-wedge was planned preoperatively by osteotomy master software, and the TFA and FFA were measured by software after simulated osteotomy. The intraoperative angle for open-wedge was adjusted according to TFA and FFA after simulated osteotomy.The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical femorotibial angle (mFTA), weight-bearing line (WBL) ratio, TFA, and FFA were measured before operation and at 2 days after operation. The difference (X) between the intraoperative measurement value and the preoperative plan value of TFA/FFA, and the difference (Y) between the postoperative WBL ratio and the target alignment (62.5%) were calculated, and the correlation between the two indicators was analyzed by Pearson’s test. According to the median BMI of patients (25.81 kg/m2), the patients were allocated into high BMI group (>25.81 kg/m2, n=10) and low BMI group (≤25.81 kg/m2, n=10), and the influencing factors of WBL ratio was analyzed by linear regression. Results There was no significant difference between pre- and post-operation in LDFA and JLCA (P>0.05); while there were significant differences between pre- and post-operation in MPTA, mFTA, and WBL ratio (P<0.05). The TFA was (89.5±4.0)° during operation and (87.7±4.7)° after operation, showing significant difference (t=2.991, P=0.008). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of TFA and the difference (Y) between the postoperative WBL ratio and the target alignment (r=0.595, P=0.006). The FFA was (86.9±4.3)° during operation and (85.7±4.4)° after operation, showing significant difference (t=1.760, P=0.094). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of FFA and the difference (Y) between the postoperative WBL ratio and the target alignment (r=0.536, P=0.015). After BMI stratification, X was an influential factor of Y in the low BMI group (P<0.05), but X was not an influential factor of Y in the high BMI group (P>0.05). Conclusion Intraoperative FFA and TFA can predict coronal limb alignment after MOWHTO. FFA and TFA can predict more preciselyfor patients with BMI≤25.81 kg/m2.
ObjectiveTo investigate the improvement of femoral rotation alignment in total knee arthroplasty (TKA) by robotic-arm assisted positioning and osteotomy and its short-term effectiveness.MethodsBetween June 2020 and November 2020, 60 patients (60 knees) with advanced osteoarthritis of the knee, who met the selection criteria, were selected as the study subjects. Patients were randomly divided into two groups according to the random number table method, with 30 patients in each group. Patients were treated with robotic-arm assisted TKA (RATKA) in trial group, and with conventional TKA in control group. There was no significant difference in gender, age, side and course of osteoarthritis, body mass index, and the preoperative hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior condylar angle (PCA), knee society score-knee (KSS-K) and KSS-function (KSS-F) scores between the two groups (P>0.05). The clinical (KSS-K, KSS-F scores) and imaging (HKA, LDFA, MPTA, PCA) evaluation indexes of the knee joints were compared between the two groups at 3 months after operation.ResultsAll patients were successfully operated. The incisions in the two groups healed by first intention, with no complications related to the operation. Patients in the two groups were followed up 3-6 months, with an average of 3.9 months. KSS-K and KSS-F scores of the two groups at 3 months after operation were significantly higher than those before operation (P<0.05), but there was no significant difference between the two groups (P>0.05). X-ray re-examination showed that the prosthesis was in good position, and no prosthesis loosening or sinking occurred. HKA, MPTA, and PCA significantly improved in both groups at 3 months after operation (P<0.05) except LDFA. There was no significant difference in HKA, LDFA, and MPTA between the two groups (P>0.05). PCA in trial group was significantly smaller than that in control group (t=2.635, P=0.010).ConclusionRATKA can not only correct knee deformity, relieve pain, improve the quality of life, but also achieve the goal of restoring accurate femoral rotation alignment. There was no adverse event after short-term follow-up and the effectiveness was satisfactory.
ObjectiveTo investigate the effect of three-dimensional (3D) printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty (TKA).MethodsBetween January 2018 and October 2018, 60 patients (60 knees) with advanced knee osteoarthritis who received TKA and met the selection criteria were selected as the study subjects. Patients were randomly divided into two groups according to the random number table method, with 30 patients in each group. The TKA was done with the help of 3D printing guide plate in the guide group and following traditional procedure in the control group. There was no significant difference in gender, age, disease duration, side, and preoperative hip-knee-ankle angle (HKA), posterior condylar angle (PCA), patella transverse axis-femoral transepicondylar axis angle (PFA), Hospital for Special Surgery (HSS) score, and American Knee Society (AKS) score (P>0.05).ResultsAll incisions healed by first intention and no complications related to the operation occurred. All patients were followed up 10-12 months, with an average of 11 months. HSS score and AKS score of the two groups at 6 months after operation were significantly higher than those before operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Postoperative X-ray films showed that the prosthesis was in good position, and no prosthesis loosening or sinking occurred during follow-up. HKA, PCA, and PFA significantly improved in the two groups at 10 months after operation compared with those before operation (P<0.05). There was no significant difference in HKA at 10 months between the two groups (t=1.031, P=0.307). PCA and PFA in the guide group were smaller than those in the control group (P<0.05).ConclusionApplication of 3D printing guide plate in TKA can not only correct the deformity of the knee joint and alleviate the pain symptoms, but also achieve the goal of the accurate femoral rotation alignment and good patellar tracking.
Commissural misalignment of biological valve and autologous valve during transcatheter aortic valve replacement may affect the filling of coronary artery, reduce the feasibility of redo-aortic valve intervention and damage the valve function, which will adversely affect long-term prognosis of patients. Some studies have obtained achievement by changing the axial direction of valve and using individualized computer simulation technology to improve the alignment technology. However, there are still many unknown problems about the impact of commissural misalignment on patients, and accurate commissural alignment techniques still need to be further explored. This article systematically expounds the possible impact of commissural misalignment between biological valve and autologous valve in transcatheter aortic valve replacement, possibly effective accurate commissural alignment techniques and related research progress.